Pupil Absence Request


Please print out the form and send it to the school when completed.
If you would like to fill in the form on your computer please click here to download the PDF version.
Free Acrobat Reader of similar required.
Note: you will still have to print it out after completion in order to sign it.

Request to take child out of school during term time

Child’s Name:   Date of Birth:
Your group/Class:

Class teacher

Contact Details (Address and mobile telephone Number)



Date of the proposed trip : –
Length and purpose of the absence :


Duration of the absence and its impact on continuity of learning:


Circumstances of the family and the wishes of parents:


The date the pupil will return to school:
UK contact details:(name, address and contact number of a relative or friend who we can make contact with if you do not return on the stated date)


Office use only

The overall % attendance pattern of the child :

2015/2016 :

2016/2017 to date :

Office use only

Leave : Authorised / Unauthorised

Signature of Headteacher :

Date :

Home School Contract

Absences in Term Time 2016-2017

At St Teilo’s School a panel is held to discuss absences taken during term time to decide whether they will be authorised or unauthorised. Each request is looked at and considered on an individual basis.

If, however, there is extended absence, then the parent/s or guardian/s will discuss with the school about taking work to ensure that the child keeps up with their education during the absence.

If the pupil/s does/do not return by the agreed date they are at risk of losing their school place/s and they will be removed from the school register in accordance with the admission guidance Education (Pupil Registration) (Wales) Regulations 2010 section 4 which states ‘the pupils has ceased to attend the school and no longer resides within a reasonable distance from the school’.

Failure to return on the agreed date will prompt welfare concerns; a child who goes missing from education may be considered to be at risk of significant harm. Any such concerns will immediately be referred to the statutory authorities for consideration.

Signed:_________________________ Parent or Guardian Date:__________

Signed:_________________________ Head teacher Date:__________